Browsing by Subject "Health"

Now showing 1 - 20 of 32
  • No Thumbnail Available
    Item
    Open Access
    A descriptive qualitative study exploring youth with intellectual disabilities participation in the community of Moshi
    (2024) Ephraim, Anthony; Galvaan, Roshan
    Introduction: Youth with intellectual disability (YID) in Tanzania are at an impasse, as they face potential exclusion from accessing services and participation in their community. This is due to existing negative cultural beliefs, lack of awareness of the needs and abilities, and limited government services. For youth attending the Gabriella Children's Rehabilitation Centre (GCRC) occupational therapy services, little is known about how they engage in occupations in the community following occupational therapy intervention nor has research been conducted to date in this regard. Such insight would be important in recognizing factors that enable or hinder youth with intellectual disability participating within their communities after rehabilitation services. Research question: How do youth with intellectual disabilities engage in occupations in the community of Moshi Kilimanjaro and what enables their participation? Aim: The study aimed to describe how youth with intellectual disabilities participate in occupations in the Moshi community, Kilimanjaro Region, Tanzania. Method: A descriptive qualitative research approach with semi-structured interviews was used to collect data from eight participants and analyzed using a thematic analysis. The ethical principles of ensuring autonomy, non-maleficence, beneficence and justice guided the research. Findings: Two major themes were identified. The first theme; ''Becoming who I can be through what I can do” with two sub-themes, namely, “Opportunities at Gabriella Centre” and “Changes and development;” and the second theme; “Connecting and earning community trust through valued occupation and routines” with three sub-themes, being; “Valued occupational routines at home and in the community”; “Trusted, given responsibility and making choices”, and “Community acceptance and support”. Discussion: The occupational based intervention for YID offered by GCRC provided considerable practical skills that facilitated YID's participation in community life. The youth became confident, and their abilities were recognized, bringing about more community acceptance. YID contributed to alleviating poverty through their engagement in the valued family and community routines. The person-centered approach was used to guide youth to make informed occupational choices. Various facets of the environment were identified as enablers and barriers to community participation. Conclusion: A well-designed program that uses a person-centered approach and reflects valued community occupations, such as the GCRC, is necessary for YID to learn skills and use their ability to participate and contribute to the community. However, it is essential to consider holistically the needs of YID. Existing policies and laws coupled with supportive families and communities can contribute to successful community participation for YID. Abstract Word Count: 396 Keywords: Youth with intellectual disability; community participation; vocational skills; household chores; valued occupations
  • No Thumbnail Available
    Item
    Open Access
    A retrospective cross-sectional analysis of palliative care needs and interventions in patients with cervical cancer in a palliative care unit in Soweto, Johannesburg
    (2023) Sobekwa, Mfanelo; Krause, Stephanie
    Introduction Cervical cancer is the second most prevalent cancer among women in South Africa. Little published research is available on the pain syndromes associated with cervical cancer and on the specific spiritual issues in patients with cervical cancer. Aim The aim of this study was to describe and provide an analysis of Palliative Care and total pain needs in patients diagnosed with cervical cancer in two Gauteng hospitals. Objectives The objectives were to determine the physical, psycho-social, and spiritual symptom burden of cervical cancer patients and assess for any correlation between a number of these symptoms and other significant variables. Methodology This study was a retrospective data analysis of 138 records of confirmed cervical cancer patients enrolled at the centre for palliative care at Chris Hani Baragwanath Academic Hospital and Sebokeng Regional Hospital. The data was analysed using SPSS version 10. Categorical variables were summarised using cross tabulation and reporting using Pearson Chi-squared test to determine if there were non-random associations between two independent categorical variables. To compare groups, means, and standard deviations with t-tests for normally distributed variables, medians, and interquartile ranges were also used. All the tests were twotailed and a p-value of less than 0.05 was considered statistically significant. The Confidence Intervals (CIs) were calculated at a 95% confidence level. Results The mean age was 50.53 (range 26-84), with 49% being below age 50 and 76% below age 60. A proportion of 41.7% of patients had an ECOG Performance status score of 0-1 which meant that they had no to little impact on the performance of daily activities. The majority of patients' performance was significantly impacted (58.3%) by their illness, bearing an ECOG score of 2 2 P a g e and above. A majority of patients (80%) reported severe to worst pain, with only 10.8% having expressed no pain at all and 2% reporting to have mild pain. The most commonly expressed distressing physical symptoms were lower abdominal pain at 75%, followed by constipation at 48%, and lower back pain at 30%. Just above two-thirds (70%) of the patients were found to be at advanced stage of the disease presenting at FIGO stage III or IV. Iron deficiency anaemia was found to be another significant clinical condition present in 80.6% of patients with a mean haemoglobin of 8.51. The most prevalent comorbid medical condition amongst this group of patients was HIV (52%) with hypertension (36%) as the second most prevalent. The data showed that 93% of the patients considered themselves spiritual, with 86% wanting a stronger connection with God or a higher being. Only 31% felt abandoned by God and 19% by their spiritual community. Further analysis revealed that 67% of patients did not feel that their illness was a punishment from a higher being and just over half of the patients (53%) felt a need to be forgiven by God for past transgressions. 81% of patients expressed a need for spiritual support as part of their clinical care. 92% of patients expressed to be worried about their illness with 87.7% being able to share how they feel with family or friends. 82.6% experienced peace despite their challenges, with only 10.9% not being at peace.93.5% still felt that life was worthwhile despite having cervical cancer. There was a positive correlation between ECOG & worry and ECOG & peace and a negative correlation between ECOG & being able to share. A negative correlation between worry and peace and a positive correlation between being able to share & peace, help for future planning & life worthwhile, information & being able to share and information and peace. Feelings of punishment seem to increase the feeling of being abandoned by a higher being, and a need for a stronger connection to a higher being emerged as a central connecting theme. Conclusion This research study highlighted that, indeed, cervical cancer patients have a number of significant palliative care needs that need to be paid attention to when treating them. These needs are multi-dimensional in nature, and some may be complex. Managing these patients requires an interdisciplinary approach and the involvement of multiple team members (including family) to respond to their needs adequately
  • Thumbnail Image
    Item
    Open Access
    Access to health care for persons with disabilities in rural South Africa
    (2017) Vergunst, R; Swartz, L; Hem, K-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M
    BACKGROUND: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. METHODS: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. RESULTS: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. CONCLUSIONS: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
  • Thumbnail Image
    Item
    Open Access
    Access to health care for persons with disabilities in rural South Africa
    (BioMed Central, 2017-11-17) Vergunst, R; Swartz, L; Hem, K.-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M
    Background: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. Methods: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Results: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. Conclusions: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
  • Thumbnail Image
    Item
    Restricted
    ARHAP International Colloquium: Collection of Concept Papers
    (University of Cape Town, 2007) African Religious Health Assets Programme
    ARHAP INTERNATIONAL COLLOQUIUM 2007, Collection of Concept Papers
  • Thumbnail Image
    Item
    Restricted
    ARHAP Tools Workshop Report
    (2004-06) Cochrane, James R; Schmid, Barbara
    The African Religious Health Assets Programme (ARHAP) was proposed in April 2002 and initiated in December of that same year, under the joint leadership of three individuals: Dr Gary Gunderson and Prof Deborah McFarland, both of Emory University (Department of International Health), and Prof James Cochrane of the University of Cape Town (Department of Religious Studies). It is the front edge of a global religious health assets initiative. It was predicated upon a conviction that faith-based organizations, groups and movements, though playing a significant role in the delivery and promotion of health, are generally not well understood or sufficiently visible to public health systems in most societies. The underlying assumption, of course, is that we need a much more “intelligent science” about the role and importance of religious health assets (RHAs) than is currently available (or if available, then only in scattered and fragmented form). This assumption stems from the growing awareness in public health bodies of all kinds, from multilateral bodies such as the UN or the WHO and international NGOs to local governments, that faith-based health activities are a very important part of the effective meeting of ideals such as those embodied in the Millennium Development Goals and their equivalents at less global levels.
  • Thumbnail Image
    Item
    Open Access
    ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle
    (2016) Bousquet, J; Hellings, P W; Agache, I; Bedbrook, A; Bachert, C; Bergmann, K C; Bewick, M; Bindslev-Jensen, C; Bosnic-Anticevitch, S; Bucca, C; Caimmi, D P; Camargos, P A M; Canonica, G W; Casale, T; Chavannes, N H; Cruz, A A; De Carlo, G; Dahl, R; Demoly, P; Devillier, P; Fonseca, J; Fokkens, W J; Guldemond, N A; Haahtela, T; Illario, M; Just, J; Keil, T; Klimek, L; Kuna, P; Larenas-Linnemann, D; Morais-Almeida, M; Mullol, J
    Abstract The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.
  • No Thumbnail Available
    Item
    Open Access
    Assisted Partner Notification for HIV: a qualitative study of providers and female patients perspectives and experiences of assisted partner notification in Cape Town, South Africa
    (2024) Perera, Shehani; Swartz, Alison
    Background Assisted partner notification (APN) is a partner notification approach where trained providers assist individuals newly diagnosed with HIV to notify their partners and then link these partners to testing and treatment services. APN has been found to be more effective at increasing HIVtesting and linkage to care rates than passive referral, where HIV-positive individuals notify partners themselves. In 2016, the WHO published official APN guidelines recommending APN for HIV. However, various factors have influenced the implementation of APN such as human rights concerns and ethical dilemmas, fear of social harm, intimate partner violence or relationship dissolution, and social and cultural factors such as gender. In South Africa, there are no specific guidelines or policies informing the implementation of APN and we are unsure about how implementation unfolds. This study sought to better understand APN by exploring patients' and providers' experiences and perceptions of APN, taking into consideration different factors that shape partner notification documented in local and international literature. The influence of religion and faith and the involvement of faith-based organisations, as well as the impact of the COVID-19 pandemic on APN for HIV also feature in this study. Methods Qualitative research methods were used in this study. Thirty-four individual, semi-structured interviews with providers (n=10), female patients (n=12) and key informants (n=12) were conducted between March 2021 and February 2022. A diary study using the WhatsApp social media platform and fieldwork journals served to triangulate the interview data collected. Data analysis involved thematic analysis incorporating an intersectional lens. The data were transcribed, then coded using NVivo software. The codes were subsequently organised into overarching themes and sub-themes. Ethics approval was obtained from the Human Research Ethics Council at the University of Cape Town (HREC Ref: 840/2020) and the City of Cape Town (Ref: 28185). Results The study found that while there are no official APN guidelines in this setting, an unofficial APN process unfolded, nevertheless. Patients' views of APN were varied; some felt providerassistance for partner notification was not required at all, others felt it was required if their attempts to notify partners failed and a few saw it as a form of interference in their personal and sexual lives. Relationship type and pre-marital HIV-testing were found to influence patients' decision-making around APN engagement. Insider and outsider narratives emerged revealing the complexities involved in making decisions about who to include or exclude during APN. Providers were found to play several roles during APN: education, facilitation/mediation, and protection. Providers also expressed how their relationships with patients could considerably influence whether patients would notify partners. Factors influencing providers' willingness to offer assistance during APN included fears of causing negative events in patients' relationships and partners not maintaining confidentiality after being notified. Providers employed various trust-building strategies to navigate these concerns. Power imbalances and gendered assumptions of health service use influenced APN substantially. Women took on a central role in partner notification due to greater healthcare involvement and societal beliefs around healthcare practices. Female patients often communicated HIV matters with female providers, revealing that caregiving roles were mostly played by women in APN. Indirect and social media based-partner notification as well as 'collusion testing', where providers and patients colluded to bring partners to clinics for testing, emerged as strategies to fulfil rights and responsibilities related to APN. While some of these effectively linked sexual partners to testing and care, it raised ethical concerns about partners' rights. Provision of APN was also found to be different between non-faith-based and faith-based providers who offered either biomedical care or a form of 'umbrella care' which incorporated biomedical and psychosocial and emotional care, respectively. The moralisation of HIV and certain sexual behaviours using religion as a moral framework imposed a sense of obligation to engage in APN. Participants were ambivalent about the involvement of church elders or pastors in APN, seeing providers as being more appropriate due to their HIV-related training. However, many acknowledged the importance of religious support in motivating them to notify partners and finding hope and resilience, if diagnosed with HIV. Conclusion This study highlights the need for clear and context-specific guidelines in implementing APN. The absence of such guidelines resulted in uncertainty among both patients and providers, hindering their participation in APN. While existing policies mention APN, the study highlights partial and limited implementation, calling attention to the need for improved, localised strategies. Trust emerged as the cornerstone of the APN process, shaping both patient and provider engagement. Trust-building strategies were important for establishing a secure environment for APN. Furthermore, the study revealed gendered dynamics in APN through which care responsibilities such as mediating between providers and male sexual partners further exacerbated the feminization of HIV. Thus, the desire for greater control, agency, and shared decision-making became evident. The exploration of FBOs in APN provision also suggests the importance of holistic care, considering spiritual and medical dimensions of healthcare journeys. Drawing parallels between COVID-19 and HIV contact tracing, the study emphasises the unique challenges posed by different contexts.
  • Thumbnail Image
    Item
    Open Access
    Association between breakfast frequency and physical activity and sedentary time: a cross-sectional study in children from 12 countries
    (BioMed Central, 2019-02-21) Zakrzewski-Fruer, Julia K; Gillison, Fiona B; Katzmarzyk, Peter T; Mire, Emily F; Broyles, Stephanie T; Champagne, Catherine M; Chaput, Jean-Philippe; Denstel, Kara D; Fogelholm, Mikael; Hu, Gang; Lambert, Estelle V; Maher, Carol; Maia, José; Olds, Tim; Onywera, Vincent; Sarmiento, Olga L; Tremblay, Mark S; Tudor-Locke, Catrine; Standage, Martyn
    Background Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods This multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance. Trial registration The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).
  • Thumbnail Image
    Item
    Open Access
    Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape
    (2021-03-01) de Villiers, Katusha
    Background Despite the end of apartheid in the early 1990s, South Africa remains racially and economically segregated. The country is beset by persistent social inequality, poverty, unemployment, a heavy burden of disease and the inequitable quality of healthcare service provision. The South African health system is currently engaged in the complex project of establishing universal health coverage that ensures the system’s ability to deliver comprehensive care that is accessible, affordable and acceptable to patients and families, while acknowledging the significant pressures to which the system is subject. Within this framework, the Bertha Centre for Social Innovation & Entrepreneurship works to pursue social impact towards social justice in Africa with a systems lens on social innovation within innovative finance, health, education and youth development. The aim of this study is to demonstrate the capacity for social innovation in health with respect for South Africa, and to highlight some current innovations that respond to issues of health equity such as accessibility, affordability, and acceptability. Methods Different data types were collected to gain a rich understanding of the current context of social innovation in health within South Africa, supported by mini-case studies and examples from across the African continent, including: primary interviews, literature reviews, and organisational documentation reviews. Key stakeholders were identified, to provide the authors with an understanding of the context in which the innovations have been developed and implemented as well as the enablers and constraints. Stakeholders includes senior level managers, frontline health workers, Ministry of Health officials, and beneficiaries. A descriptive analysis strategy was adopted. Results South Africa’s health care system may be viewed, to a large extent, as a reflection of the issues facing other Southern African countries with a similar disease burden, lack of systemic infrastructure and cohesiveness, and societal inequalities. The evolving health landscape in South Africa and the reforms being undertaken to prepare for a National Healthcare Insurance presents the opportunity to understand effective models of care provision as developed in other African contexts, and to translate these models as appropriate to the South African environment. Conclusions After examining the cases of heath innovation, it is clear that no one actor, no matter how innovative, can change the system alone. The interaction and collaboration between the government and non-state actors is critical for an integrated and effective delivery system for both health and social care.
  • Thumbnail Image
    Item
    Open Access
    Case Study Focus: Papers and Proceedings
    (University of Cape Town, 2017-03-28) ARHAP International Colloquium
    ARHAP seeks to develop a systematic knowledge base of religious health assets in sub-Saharan Africa; thus to assist in aligning and enhancing the work of both religious health leaders and public policy makers in their collaborative effort to meet the challenge of disease, e.g. HIV/AIDS; and hence to promote sustainable health, especially for those who live in poverty or under marginal conditions.
  • No Thumbnail Available
    Item
    Open Access
    Characterizing various aspects of the male genital tract barrier function and immunity
    (2024) Rametse, Cosnet; Gray, Clive; Chigorimbo-Tsikiwa Nyaradzo
    There has been significant progress in the management of Human Immunodeficiency Virus-1 (HIV-1) infection and prevention globally since the availability of antiretroviral drugs (ARVs). Due to a combination of ARV availability, increased HIV testing, and the introduction of a range of HIV prevention tools, HIV mortality in Africa has declined. However, HIV remains a global burden that still needs urgent attention, as there is still a high rate of new HIV infections globally and in South Africa. Effective control of this epidemic requires a complete understanding of the mechanisms of transmission and acquisition of this virus. HIV acquisition in men through penile exposure is one of the least studied modes of HIV transmission. Voluntary medical male circumcision (VMMC) is associated with a 60% reduced risk of HIV acquisition through heterosexual intercourse. However, uncircumcised men comprise approximately 70% of the male population worldwide, implying that although an effective prevention method has been shown, many men remain uncircumcised. Furthermore, it is not well understood why there remains a group of circumcised males who remain susceptible to infection. Understanding the immune milieu in the male genital tract may reveal additional HIV susceptibility mechanisms and factors that can be used as a foundation for alternative HIV preventative strategies. This PhD thesis examines barrier function, the density of HIV target cells and various expressed epithelial barrier proteins and genes in different anatomical sites of the intact penis before VMMC and in foreskin tissue after surgical removal. How these measurements are impacted by asymptomatic STIs is explored. The central hypothesis is that the inner foreskin has a relatively reduced barrier function compared to the other penile sites, which is further reduced by the presence of asymptomatic STIs (aSTIs). To test this hypothesis, the following aims were explored: 1. To describe the prevalence of aSTIs, including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium at two medical circumcision clinics in the Western Cape, South Africa. 2. To characterize in vivo and ex vivo penile barrier function, represented by transepithelial water loss (TEWL), surface hydration and water content in the glans, foreskin and shaft and further examine how this is impacted by common aSTI and VMMC. 3. To evaluate inflammatory inner and outer foreskin changes associated with aSTIs. 4. To compare spatial transcriptomic patterns in macrophages and epithelial cells between the inner and outer foreskin in the presence of an aSTI. 5. To examine the impact of in vivo Oral Pre-Exposure Prophylaxis (PrEP) on claudin-1 expression and lymphoid/myeloid cells in the foreskin (Published manuscript chapter) Methods Male volunteers who were undergoing VMMC were recruited from community clinics in Retreat, TC-Newman and Mitchells Plain, Western Cape. Multiplex PCR testing was performed on first-pass urine samples collected from 320 HIV-negative male participants to screen for the prevalence of common curable aSTIs: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. Penile in vivo hydration (n=203) was measured using vapometers, moisture meters SC and D, epi-D to measure proxy barrier function in the absence and presence of an aSTI. Longitudinal measurements were made at 2, 12 (n=28) and 24 weeks (n=16) after VMMC. Foreskin (FS) tissue was collected from a subset of 96 males and examined using histological scoring and gene expression using RTqPCR of Filaggrin, Involucrin, E-cadherin and Claudin. Spatially resolved gene expression in CD68+ macrophages and pan-cytokeratin epithelial cells was made from 8 foreskin tissue samples dissected into inner and outer tissue. Using a DeltaVision Elite microscope, the density of CD4+CCR5+, CD1a+ cells, and percent claudin-1 expression were analyzed in 144 male participant foreskin tissue samples from a randomized on-demand pre-exposure prophylactic clinical trial. Results The overall prevalence of asymptomatic STIs was 15.9%, where the highest prevalence was Chlamydia (12.2%) followed by Mycoplasma genitalium (4.38%,). Marital and educational status were significantly associated with a lower risk of any STI. In vivo measurements of the penile glans, inner foreskin and shaft barrier function show that the trans-epithelial water loss (TEWL) of the inner foreskin (median 27.6 g/hr/m2 ) and glans (median 22.3 g/hr/m2 ) of uncircumcised males was significantly higher compared to the shaft (median 16.2 g/hr/m2 ) of the penis (p<0.0001). Analysis by aSTI status revealed that in the presence of an aSTI, stratum corneum surface hydration in the penile glans was significantly higher (97.4au vs 52.3au; p=0.038). Six months post-circumcision, TEWL in the glans was significantly decreased (p=0.011) from baseline (pre-VMMC), matching that of the shaft. Histological measurements show that total immune cell density was higher in aSTI+ (n=38) vs aSTI- males (n=58), in the epidermis (24.6 vs 10.4 cells /m2 p=0.002), papillary dermis (119.9 vs 61.4 cells/m2 , p=0.014) and reticular dermis (13.6 vs 6.5 cells/m2 , p=0.03). These were predominantly lymphocytic infiltrates that were largely in the papillary dermis. Claudin-1 percent expression was significantly decreased in the inner foreskin compared to the outer foreskin in the presence of an aSTI. This was matched by increased penile glans surface hydration in the presence of an aSTI (58.3 vs 105.6 au, p=0.003). Transcriptomic data showed that in the presence of asymptomatic chlamydia infection, macrophages, and epithelial cells of the inner foreskin showed predominant upregulation of immune-associated genes and pathways such as increased HLA-DQA1, HLA-DQB1 and HLA-DRB1, IL7R expression. Whereas the outer foreskin showed significant downregulation in protein synthesis genes. Examining the impact of ARV alone on the on foreskin immune and barrier function markers in a randomized PrEP study, showed no significant difference in the density of CD4+CCR5+ or CD1a+ cells in foreskins between treatment arms compared with the control arm. Claudin-1 expression was 34% higher (p=0.003) relative to controls in the ARV arm, but after multiple comparisons was no longer statistically significant. Conclusions The difference in TEWL between those with and without an aSTI showed that the uncircumcised penis has a lower barrier function compared to the penis after VMMC. Additionally, the presence of an aSTI significantly increased inflammatory cells in the foreskin epidermis and dermis, with most infiltrates localizing within the papillary dermis. This is associated with decreased expression of Claudin in the inner foreskin (hence reduced barrier integrity) and increased moisture in the glans. These findings show that aSTI's alter gene expression in key immunological cells and in epithelia that have implications for potentially elevating the risk of HIV infection in uncircumcised males. This PhD is also the first to show that oral dosage and timing of on-demand PrEP have no effect on the numbers or anatomical location of lymphoid or myeloid HIV target cells in foreskin tissue. Overall, The high burden of chlamydia and concurrent STIs highlights the urgent need to improve the prevention, detection, and appropriate management of sexually-acquired infections in young men as they profoundly impact epithelial integrity and immunological events in the foreskin. Screening of aSTIs should be encouraged among young men.
  • Thumbnail Image
    Item
    Open Access
    Children’s route choice during active transportation to school: difference between shortest and actual route
    (2016) Dessing, Dirk; de Vries, Sanne I; Hegeman, Geertje; Verhagen, Evert; van Mechelen, Willem; Pierik, Frank H
    BackgroundThe purpose of this study is to increase our understanding of environmental correlates that are associated with route choice during active transportation to school (ATS) by comparing characteristics of actual walking and cycling routes between home and school with the shortest possible route to school.MethodsChildren (n = 184; 86 boys, 98 girls; age range: 8–12 years) from seven schools in suburban municipalities in the Netherlands participated in the study. Actual walking and cycling routes to school were measured with a GPS-device that children wore during an entire school week. Measurements were conducted in the period April–June 2014. Route characteristics for both actual and shortest routes between home and school were determined for a buffer of 25m from the routes and divided into four categories: Land use (residential, commercial, recreational, traffic areas), Aesthetics (presence of greenery/natural water ways along route), Traffic (safety measures such as traffic lights, zebra crossings, speed bumps) and Type of street (pedestrian, cycling, residential streets, arterial roads). Comparison of characteristics of shortest and actual routes was performed with conditional logistic regression models.ResultsMedian distance of the actual walking routes was 390.1m, whereas median distance of actual cycling routes was 673.9m. Actual walking and cycling routes were not significantly longer than the shortest possible routes. Children mainly traveled through residential areas on their way to school (>80% of the route). Traffic lights were found to be positively associated with route choice during ATS. Zebra crossings were less often present along the actual routes (walking: OR = 0.17, 95 % CI = 0.05–0.58; cycling: OR = 0.31, 95 % CI = 0.14–0.67), and streets with a high occurrence of accidents were less often used during cycling to school (OR = 0.57, 95% CI = 0.43–0.76). Moreover, percentage of visible surface water along the actual route was higher compared to the shortest routes (walking: OR = 1.04, 95 % CI = 1.01–1.07; cycling: OR = 1.03, 95 % CI = 1.01–1.05).DiscussionThis study showed a novel approach to examine built environmental exposure during active transport to school. Most of the results of the study suggest that children avoid to walk or cycle along busy roads on their way to school.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0373-y) contains supplementary material, which is available to authorized users.
  • No Thumbnail Available
    Item
    Metadata only
    Concurrent sexual partnerships and sexually transmitted diseases among African men in Cape Town, South Africa
    (Southern Africa Labour and Development Research Unit, 2015-05-28) Maughan-Brown, Brendan
  • Thumbnail Image
    Item
    Restricted
    The contribution of Religious Entities to Health Sub-Saharan Africa
    (2008-05) Schmid, Barbara; Thomas, Elizabeth; Olivier, Jill; Cochrane, James R
    Background: While most partners in providing health care in sub-Saharan Africa agree that religious entities play an important role in providing health services, there is little comprehensive data about the scope and scale of their contribution, beyond data held by particular religious entities about their own health related work. In addition not much is known, beyond claims and often repeated statements, about the ways in which such health care is different from services provided in the public health system. 2. Aims and Objectives The overall purpose of this study was to provide a description of the contribution of faith based organisations (FBOs), institutions, and networks to the health of vulnerable populations in resource-poor areas of sub-Saharan Africa (SSA); and to identify key areas for investment that would accelerate, scale up and sustain access to effective services, and/or encourage policy and resource advocacy among and in African countries. There were two main parts to the objectives: 1) To give an overview for SSA of the coverage, role, and core health related activities of religious entities, including major networks, vis a vis public and other private sector health services delivery, and their relationship to government and to each other. 2) To give more detailed information for three country case studies in Mali, Uganda and Zambia: a) describing the capacity of faith based organisations to deliver health services and impact on health behaviour; the financial and/or material support they receive and how they are perceived by stakeholders; b) characterizing key faith based networks and describing how they work; c) describing how faith based organisations collaborate with each other and with governments. From these were to be drawn recommendations about key areas for potential investment that would improve population health outcomes. 3. Research overview: The research was conducted under the auspices of the African Religious Health Assets Programme (ARHAP), a research networks focussed on gaining a better understanding of the contribution of religious health assets to public health in Africa. The team of ARHAP researchers, from the University of Cape Town and the Medical Research Council was supported by an international, inter-disciplinary and multi-religious advisory group as well as in-country researchers.
  • Thumbnail Image
    Item
    Open Access
    The Determinants of Perceived Health and Labour Force Participation of People with HIV/AIDS in Khayelitsha, South Africa
    (2006) Coetzee, Celeste; Tasiran, Ali
    This paper examines the impact of Highly Active Antiretroviral Treatment (HAART) on perceived health and labour force participation of people living with HIV/AIDS in Khayelitsha, South Africa. Cox Proportional Hazard Models with stratum effects for three medical clinics, and Accelerated Failure Time Models with individual specific unobserved shared effects (frailty), are estimated for transitions to improved perceptions of health, and transition in and out of the labour market, using a longitudinal data set. We find that HAART has a positive impact on perceived health, and restored health leads to greater activity in the labour market.
  • No Thumbnail Available
    Item
    Metadata only
    Evaluating the Impact of Health Programmes
    (Southern Africa Labour and Development Research Unit, 2015-05-28) Burns, Justine; Keswell, Malcolm; Thornton, Rebecca
  • No Thumbnail Available
    Item
    Open Access
    Factors associated with health information systems that influence continuity of TB care between a District hospital and Primary Healthcare facilities
    (2024) Esack, Tasneem; Gilson, Lucy
    Background: South Africa is well known to have a high burden of Tuberculosis (TB) disease. The Western Cape has been identified as having one of the highest numbers of new infections of TB per year in South Africa. TB is the cause of significant mortality and morbidity and has substantial financial implications for patients and the health system. As a result of high levels of HIV, poverty and overcrowding TB has been difficult to eradicate. The significant burden of disease, the caseloads and staff shortages also contribute to challenges to successfully continuing care of TB patients. It has been noted that as much as 24% of TB patients may be lost to follow up (LTFU) in certain districts of the Western Cape. While previous studies have looked at factors that influence LTFU and continuity of care (COC), no studies have examined how the design and use of Health Information Systems (HIS) may influence these outcomes. This study aims to describe the current use of HIS in the discharge process of a TB patient at a district hospital in Western Cape and further aims to identify how HIS may facilitate or create barriers to successfully continuing a patient's TB treatment at primary healthcare level after discharge from a district hospital. Methods: The study was conducted through two phases. Phase 1, secondary data analysis of process maps previously created to understand the TB care pathways and the associated gaps in care within a district hospital and phase 2, a semi-structured interview process. Analysis of both phases involved qualitative thematic analysis attempting to identify and unpack Health Information Systems (HIS) challenges associated with TB care. Results: Barriers were identified which prevented seamless use of HIS and which did not promote COC. These included poor understanding of TB administrative and referral processes, and what is required to successfully link to TB care and continue care at primary healthcare (PHC) facilities. Further barriers were resources and usability of the HIS, as well as data integrity and fragmented HISs. The only facilitators identified was the availability of clinical information where access was possible and data was complete, as well as an electronic referral platform to TB hospitals. Conclusion: Obstacles exist to the effective utilization of HISs in ensuring continuity of TB care between district hospitals and community clinics. To mitigate some of these limitations, we propose that training on SOPs, HISs, and administrative procedures for TB management be intensified. Clarifying ambiguities regarding data, workflows, and HIS prerequisites that support COC could help HCWs better facilitate COC through HIS usage. Additionally, organizations should strive to minimize resource deficiencies hindering HIS utilization. Insights from the TB hospital referral system can be leveraged to enhance care linkage.
  • No Thumbnail Available
    Item
    Metadata only
    Health seeking behaviour in northern KwaZulu-Natal
    (CSSR and SALDRU, 2015-05-28) Case, Anne; Menendez, Alicia; Ardington, Cally
  • No Thumbnail Available
    Item
    Metadata only
    Health, Health Seeking Behavior, and Health Care
    (2017-06-06) Ardington, Cally; Case, Anne